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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(04): 345-347
DOI: 10.1055/s-0042-1759681
Case Report

Perianal Psoriasis as the First Manifestation of the Disease

Claudia Alejandra Aceves Quintero
1   Hospital Ángeles Pedregal, Mexico City, Mexico
,
Miguel Ángel Rosado Martínez
2   Hospital Faro del Mayab, Mérida, Yucatán, Mexico
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Abstract

Introduction Inverse psoriasis affects the skin of flexural areas, such as the groin, axillae, umbilicus, intergluteal fold, and external genitalia.

Clinical Case We herein report the case of a man who presented with anal pruritus and, upon physical examination, a perianal dermatosis was found, which was characterized by erythematous plaques, with fine scaling. The case was initially managed with zinc oxide, and when no improvement was observed, we decided to take an incisional biopsy, which indicated histological changes suggestive of psoriasiform dermatitis.

Discussion Inverse psoriasis affects 3% to 7% of patients with psoriasis, and it manifests with erythematous plaques without the classic scaling appearance. The skin in these areas is susceptible to maceration, irritation, and ulceration, which alter the classic clinical picture. It may present with typical lesions or, less frequently, in isolation in the anogenital region. In the anogenital presentation only, the diagnosis should be made by biopsy, looking for the classic histopathological features of psoriasis. As for the first-line treatment, low- or medium-potency topical steroids are used for short periods of time; the second-line treatment is with emollients and tar-based products; and the third-line treatment uses an immunomodulator.

Conclusion This presentation is infrequent, and it requires a high index of suspicion for the diagnosis, always supported by biopsies, in search of the classic histopathological features of psoriasis.

Keywords

perianal psoriasis - inverse psoriasis - perianal pruritus


Publication History

Received: 21 August 2022

Accepted: 25 October 2022

Article published online:
22 December 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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